Provider Demographics
NPI:1902056484
Name:HANNAH, COLLEEN ERIN GOFF (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:ERIN GOFF
Last Name:HANNAH
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28716-4524
Mailing Address - Country:US
Mailing Address - Phone:828-361-7911
Mailing Address - Fax:
Practice Address - Street 1:25 REYNOLDS MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-1270
Practice Address - Country:US
Practice Address - Phone:828-645-6619
Practice Address - Fax:828-645-6528
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8490235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist